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Arch Phys Med Rehabil. 2016 Jan;97(1):17-25. doi: 10.1016/j.apmr.2015.08.412. Epub 2015 Aug 22.

Dextrose Prolotherapy Versus Control Injections in Painful Rotator Cuff Tendinopathy.

Author information

1
Department of Family Practice, School of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
2
Department of Physical Medicine and Rehabilitation, University of Kansas, Kansas City, KS. Electronic address: DeanReevesMD@gmail.com.
3
Private Practice, West Vancouver, British Columbia, Canada.
4
Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada.
5
School of Nursing and Health Studies, University of Missouri-Kansas City, Kansas City, MO.

Abstract

OBJECTIVE:

To compare the effect of dextrose prolotherapy on pain levels and degenerative changes in painful rotator cuff tendinopathy against 2 potentially active control injection procedures.

DESIGN:

Randomized controlled trial, blinded to participants and evaluators.

SETTING:

Outpatient pain medicine practice.

PARTICIPANTS:

Persons (N=73) with chronic shoulder pain, examination findings of rotator cuff tendinopathy, and ultrasound-confirmed supraspinatus tendinosis/tear.

INTERVENTIONS:

Three monthly injections either (1) onto painful entheses with dextrose (Enthesis-Dextrose), (2) onto entheses with saline (Enthesis-Saline), or (3) above entheses with saline (Superficial-Saline). All solutions included 0.1% lidocaine. All participants received concurrent programmed physical therapy.

MAIN OUTCOME MEASURES:

Primary: participants achieving an improvement in maximal current shoulder pain ≥2.8 (twice the minimal clinically important difference for visual analog scale pain) or not. Secondary: improvement in the Ultrasound Shoulder Pathology Rating Scale (USPRS) and a 0-to-10 satisfaction score (10, completely satisfied).

RESULTS:

The 73 participants had moderate to severe shoulder pain (7.0±2.0) for 7.6±9.6 years. There were no baseline differences between groups. Blinding was effective. At 9-month follow-up, 59% of Enthesis-Dextrose participants maintained ≥2.8 improvement in pain compared with Enthesis-Saline (37%; P=.088) and Superficial-Saline (27%; P=.017). Enthesis-Dextrose participants' satisfaction was 6.7±3.2 compared with Enthesis-Saline (4.7±4.1; P=.079) and Superficial-Saline (3.9±3.1; P=.003). USPRS findings were not different between groups (P=.734).

CONCLUSIONS:

In participants with painful rotator cuff tendinopathy who receive physical therapy, injection of hypertonic dextrose on painful entheses resulted in superior long-term pain improvement and patient satisfaction compared with blinded saline injection over painful entheses, with intermediate results for entheses injection with saline. These differences could not be attributed to a regenerative effect. Dextrose prolotherapy may improve on the standard care of painful rotator cuff tendinopathy for certain patients.

KEYWORDS:

Glucose; Regenerative medicine; Rehabilitation; Rotator cuff; Shoulder; Tendinopathy

PMID:
26301385
DOI:
10.1016/j.apmr.2015.08.412
[Indexed for MEDLINE]

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